The Profile of Cypermethrin Intoxication as Differential Diagnosis of Organophosphate Poisoning: A Case Report

Cypermethrin, a type II pyrethroid, is easily available over the counter, increasing the possibility of accidental and intentional exposures. Severe Cypermethrin exposure is rare but may lead to an organophosphate-like toxidrome, posing a diagnostic quandary to the critical care personnel. The authors present a case of a 25-year-old lady patient, who intentionally ingested a toxin or poison. On repeated investigation by medical personnel and family members, it eventually turned out to be cyperhit. On, immediate shifting to the Intensive Care Unit (ICU) following acute poisoning, her vital signs were more or less stable, but with mouth filled with copious mouth secretions and mild bronchorrhoea. An intravenous dose of 1.2 mg of atropine sulfate was administered because of bronchorrhoea, which led to satisfactory improvement, except for hypoglycaemia {(Random Blood Sugar(RBS): 67 mg/dL}. To address hypoglycaemia, an initial bolus of 25% dextrose (IV)/100 mL was injected followed by an infusion of 25% dextrose at a rate of 10 ml/hr. At the end of three days of close monitoring and psychiatric counseling sessions, she was fully alert, oriented, afebrile, and had stable vital signs. The present case suggests that Cypermethrin poisoning should be considered a differential diagnosis of patients presenting with classical features of organophosphorus poisoning. Inadvertent administration of pralidoxime and atropine can be avoided if emergency physicians are aware of this entity. Optimum Atropine administration is useful when the dose is adjusted as per the patient’s response.